What to Expect During and After Dry Needling Treatment: A Patient's Guide
If you've scheduled your first dry needling appointment, you might be feeling a mix of excitement and nervousness. What will it feel like? How long does it take? What happens afterward? This comprehensive guide walks you through exactly what to expect before, during, and after your dry needling treatment at Well Equipt Physical Therapy in Atlanta, so you can feel confident and prepared for your session.
Not sure if dry needling is for you? Check out our blog post on the conditions helped by dry needling.
Before Your Appointment: How to Prepare
Preparing for your dry needling session can help maximize your results and minimize any discomfort.
What to Wear: Wear loose, comfortable clothing that allows easy access to the treatment area. For example:
Tank tops or loose shirts for shoulder and neck treatments
Shorts or athletic pants for hip, leg, or low back treatments
Sports bra or loose top for mid-back treatments
Hydration Matters: Drink plenty of water in the 24 hours leading up to your appointment. Well-hydrated muscles respond better to treatment and tend to have less post-treatment soreness.
Eat Something: Have a light meal or snack 1-2 hours before your appointment. Coming in on an empty stomach can increase the likelihood of feeling lightheaded during treatment.
Communicate: Be ready to discuss your pain history, current symptoms, and treatment goals. Let your therapist know if you're nervous about needles; this is completely normal, and we can adjust our approach to help you feel comfortable.
Your First Visit: The Initial Assessment
Before any needles are introduced, your physical therapist will conduct a thorough evaluation to create a personalized treatment plan.
Medical History Review: Your therapist will ask about:
Your current pain or injury
How long you've been experiencing symptoms
Previous treatments you've tried
Any medical conditions or medications
Whether you've had dry needling before
Physical Examination: Your therapist will:
Observe your posture and movement patterns
Test your range of motion
Assess muscle strength and flexibility
Palpate (feel) your muscles to identify trigger points, tight bands, and areas of restriction
Perform special tests relevant to your condition
Treatment Planning: Based on the assessment, your therapist will explain:
Which muscles and trigger points will be targeted
How dry needling fits into your overall treatment plan
What results you can expect and over what timeframe
How many sessions you might need
This is your opportunity to ask questions and voice any concerns before treatment begins.
Step-by-Step: Your Dry Needling Session
Now let's walk through what actually happens during treatment.
Step 1: Positioning (2-3 minutes)
Your therapist will position you comfortably on the treatment table. Depending on the area being treated, you might be:
Lying face down for back, neck, or posterior shoulder treatment
Lying face up for front of the shoulder, hip flexors, or anterior leg muscles
Side-lying for lateral hip or shoulder treatment
Pillows and bolsters will be used to support your body and ensure you're relaxed. Muscle tension makes trigger points harder to release, so comfort is key.
Step 2: Area Preparation (1 minute)
The treatment area will be cleaned with alcohol to ensure proper hygiene. Your therapist will palpate the area one more time to precisely locate the trigger points that need to be addressed.
Step 3: Needle Insertion (Variable timing)
Here's where the treatment begins:
The Needles: The needles used are extremely thin - much finer than the needles used for injections or blood draws. They're solid (not hollow) and sterile, single-use needles that are disposed of immediately after your session.
Initial Insertion: When the needle first penetrates the skin, you might feel:
A brief pinch or prick (often described as less painful than a mosquito bite)
Slight pressure
Sometimes nothing at all; many patients are surprised they didn't feel the needle enter
Reaching the Trigger Point: As the needle advances into the muscle and reaches the trigger point, sensations vary:
Deep Ache: A dull, achy sensation that feels like pressure deep in the muscle
Muscle Twitch: An involuntary jump or twitch of the muscle (this is actually a positive sign that indicates the trigger point is being released!)
Referred Sensation: You might feel a sensation that radiates to another area; for example, needling a neck trigger point might produce a sensation down your arm. This is normal and shows that your therapist has found an active trigger point
Reproduction of Your Pain: Sometimes the needle will recreate your familiar pain pattern. While momentarily uncomfortable, this confirms your therapist is treating the right spot
Important to Remember: These sensations are brief and temporary. Many patients describe it as "a weird but not really painful" feeling. The discomfort level is typically a 3-4 out of 10 at most, and it lasts only a few seconds.
Step 4: Needle Techniques (5-20 minutes total)
Your therapist will use one or more of these techniques:
Pistoning: The needle is gently moved in and out to elicit multiple twitch responses. This helps fully release the trigger point. Each "piston" lasts just 1-2 seconds.
Static Needling: The needle is left in place for several minutes to allow the muscle to relax around it. You'll likely feel the initial sensation fade away as the muscle releases.
Combination Approach: Often, therapists will use pistoning to release the trigger point, then leave the needle in place to maintain the release.
Multiple Sites: Depending on your condition, your therapist may treat 3-8 different trigger points in one session. They'll work systematically through the identified areas, removing each needle before moving to the next, or treating multiple points simultaneously.
Step 5: Needle Removal (Seconds per needle)
Needle removal is quick and typically painless. You might not even feel it happen. Your therapist will apply brief pressure to any sites that show minor bleeding (this is rare and normal).
Step 6: Post-Treatment Assessment (2-3 minutes)
After the needles are removed, your therapist will:
Check in about how you're feeling
Have you perform some movements to assess immediate changes
Explain what to expect over the next 24-48 hours
Provide aftercare instructions
Total Session Time: A typical dry needling session takes 30-60 minutes, including assessment and post-treatment discussion.
Immediately After Treatment: What You'll Notice
Responses to dry needling vary from person to person, but here's what's common:
Immediate Relief: Many patients experience instant improvements:
Reduced pain or discomfort
Increased range of motion
Feeling of lightness or ease in the treated area
Ability to move in ways that were previously restricted
Delayed Response: Some patients don't notice significant changes immediately. This doesn't mean the treatment didn't work; benefits often emerge over the next 24-72 hours as the inflammatory healing response progresses.
Muscle Fatigue: The treated muscles may feel tired or slightly heavy, similar to how muscles feel after a massage. This is temporary and normal.
Mild Soreness: You might notice some tenderness starting within a few hours. This is expected and indicates your body's healing response is activating.
The First 24-48 Hours: Managing Common Side Effects
Understanding what's normal helps you navigate the post-treatment period with confidence.
Expected Side Effects and How to Manage Them
Muscle Soreness (Most Common):
What it feels like: Deep, achy soreness similar to delayed onset muscle soreness after a workout. Typically peaks 12-24 hours after treatment.
Why it happens: The needle creates controlled micro-trauma that triggers an inflammatory healing response. This is actually part of the therapeutic process.
How to manage it:
Apply heat to the area (heating pad, warm shower, or bath) to increase circulation and reduce stiffness
Stay gently active - light movement helps more than complete rest
Stay well-hydrated to help flush metabolic waste products
Take over-the-counter pain relievers if needed (check with your therapist first)
Avoid intense workouts or heavy lifting for 24-48 hours
Gentle stretching can help, but avoid aggressive stretching of the treated area
Duration: Usually resolves within 24-48 hours, though occasionally lasts up to 72 hours.
Minor Bruising:
What it looks like: Small bruises at needle insertion sites, typically the size of a dime or smaller.
Why it happens: Occasionally a needle may hit a small blood vessel. This is harmless and doesn't indicate a problem.
How to manage it:
Apply ice for 10-15 minutes if you notice bruising developing
Bruises will fade naturally within a week
Arnica cream or gel may help reduce bruising (consult your therapist)
When it occurs: About 10-20% of patients experience minor bruising.
Minor Bleeding:
What happens: A small drop of blood at the needle site when removed.
Why it happens: The needle passed through a tiny capillary.
How to manage it:
Your therapist will apply pressure immediately
Keep the area clean for 24 hours
It's completely normal and not a concern
Temporary Fatigue:
What it feels like: Overall tiredness or a need to rest, especially after your first session.
Why it happens: Your body is directing energy toward the healing process.
How to manage it:
Listen to your body and rest if needed
Maintain normal sleep schedule
Stay hydrated
Eat nutritious meals to support healing
Lightheadedness (Rare):
What it feels like: Feeling woozy, dizzy, or faint during or immediately after treatment.
Why it happens: Typically related to anxiety about needles or coming in on an empty stomach.
How to manage it:
Inform your therapist immediately if you feel this way
Your therapist will have you lie down and elevate your legs
Deep breathing helps
This passes quickly and is not dangerous
Prevention: Eat before your appointment and communicate any needle anxiety to your therapist.
Red Flags: When to Contact Your Therapist
While serious complications are extremely rare, contact your therapist if you experience:
Increasing (rather than decreasing) pain after 48 hours
Signs of infection (increasing redness, warmth, swelling, or fever)
Severe or unusual pain
Difficulty breathing or chest pain (extremely rare but requires immediate medical attention)
Numbness or tingling that doesn't resolve within a few hours
Days 3-7: Experiencing the Full Benefits
For most patients, this is when the real magic happens.
Peak Benefits:
Pain levels often drop significantly
Movement becomes easier and more fluid
You notice you're not thinking about your pain as much
Activities that were difficult become manageable again
Why Now: The initial inflammatory response has done its job, and your tissue is now in the healing and remodeling phase. Blood flow has been restored to previously ischemic areas, trigger points have been deactivated, and your neuromuscular system has begun to reset.
What to Do: This is the perfect time to reinforce the changes through targeted exercises and movement. Your body is primed to learn new, healthier movement patterns.
Integrating Dry Needling with Physical Therapy: The Key to Lasting Results
Here's an important truth: dry needling alone is rarely the complete solution. The real power comes from combining dry needling with a comprehensive physical therapy program.
Why Combination Treatment Works Best
Dry Needling Opens the Window: Think of dry needling as opening a window of opportunity. It:
Releases muscle tension and trigger points
Reduces pain that may have been limiting your ability to exercise
Restores range of motion
Creates an optimal environment for healing
Exercise Keeps the Window Open: But if you don't follow up with appropriate exercises and movement re-education, that window will close. Muscles can develop trigger points again if:
Underlying movement dysfunction isn't addressed
Weakness and imbalances persist
Poor posture or ergonomics continue
You return to the same activities that caused the problem
Your Comprehensive Treatment Plan
At Well Equipt Physical Therapy, we integrate dry needling into a holistic approach:
Phase 1: Pain Reduction (Weeks 1-2)
Dry needling to release trigger points and reduce acute pain
Gentle range of motion exercises
Manual therapy techniques
Pain management strategies
Education on posture and ergonomics
Phase 2: Restoration (Weeks 3-4)
Continued dry needling as needed (typically less frequent)
Progressive strengthening exercises targeting weaknesses
Flexibility and mobility work
Functional movement training
Introduction to proper body mechanics
Phase 3: Prevention and Optimization (Weeks 5+)
Occasional "tune-up" dry needling sessions if trigger points begin to return
Advanced strengthening and conditioning
Sport or activity-specific training
Long-term home exercise program
Strategies for maintaining results
Exercises That Complement Dry Needling
Your specific exercise program will be tailored to your condition, but here are common examples:
After Neck Dry Needling:
Chin tucks to strengthen deep neck flexors
Scapular stabilization exercises
Upper trap stretches
Postural awareness training
After Low Back Dry Needling:
Core stabilization exercises (dead bugs, bird dogs)
Hip flexor and hamstring stretches
Glute strengthening (bridges, clamshells)
Spinal mobility exercises
After Shoulder Dry Needling:
Rotator cuff strengthening (external/internal rotation)
Scapular control exercises (rows, Y-T-W movements)
Posterior capsule stretching
Postural correction exercises
The Timing: Light, gentle movement can begin the same day as treatment. More intensive exercises typically start 24-48 hours after dry needling, once initial soreness has subsided. Your therapist will provide specific guidance based on your response to treatment.
Maximizing Your Results: Pro Tips from Our Physical Therapists
Want to get the most out of your dry needling treatments? Follow these evidence-based strategies:
Before Each Session
Stay Hydrated: Drink at least 64 ounces of water daily, especially the day before and day of treatment. Hydrated muscles respond better and have less post-treatment soreness.
Get Good Sleep: Your body does most of its healing during sleep. Aim for 7-9 hours, especially in the days following treatment.
Avoid Alcohol: Skip alcohol for 24 hours before and after treatment, as it can increase bruising and interfere with the healing response.
Continue Prescribed Exercises: The exercises you've been given between sessions are crucial. Consistency matters more than intensity.
During Treatment
Communicate: Tell your therapist about:
What you're feeling during needling
Any changes in your symptoms since the last session
Activities that have been easier or harder
Any concerns or questions
Breathe: Deep, relaxed breathing helps muscles stay relaxed, making trigger points easier to release. Try slow belly breathing during needle insertion.
Trust the Twitch: If you feel muscle twitching, that's excellent! It means the trigger point is releasing. Don't tense up - let it happen.
After Treatment
Move Gently: Go for a 10-15 minute walk after your session to promote circulation and reduce stiffness. Avoid complete rest, but also avoid intense activity.
Use Heat: A warm shower or heating pad for 15-20 minutes can help reduce post-treatment soreness.
Do Your Homework: Perform the exercises your therapist prescribes. This is not optional; it's the difference between temporary relief and lasting change.
Track Your Progress: Keep notes on:
Pain levels throughout the week (use a 0-10 scale)
Activities that are easier or still challenging
How long relief lasts after each session
Any patterns you notice
This information helps your therapist adjust your treatment plan for optimal results.
Long-Term Prevention
Address the Root Cause: Identify and modify the factors that contributed to your trigger points:
Improve workstation ergonomics
Correct poor posture habits
Address muscle imbalances and weaknesses
Modify training techniques if sports-related
Manage stress (a major contributor to muscle tension)
Maintain Your Gains:
Continue a modified version of your PT exercises 2-3x weekly
Schedule periodic maintenance visits if you're prone to trigger point recurrence
Use self-care techniques like foam rolling and stretching
Address new issues early, before they become chronic
Listen to Your Body: Early warning signs that trigger points are developing:
Muscle stiffness that doesn't resolve with stretching
Reduced range of motion
Familiar pain patterns starting to return
Muscle fatigue or weakness
If you notice these signs, schedule a follow-up appointment before the problem escalates.
Common Questions Patients Ask
"How many sessions will I need?"
This varies based on your condition. Acute issues may resolve in 1-3 sessions, while chronic problems often require 4-8 sessions. Your response to the first treatment helps guide this timeline. We'll reassess after each session and adjust the plan accordingly.
"How often should I come in?"
Initially, appointments are typically scheduled 1-2 times per week. As you improve, we space sessions to every 2-3 weeks, and eventually to occasional maintenance visits. The goal is always to get you better and keep you better with minimal ongoing intervention.
"What if I'm really nervous about needles?"
This is completely normal! Tell your therapist. We can start with areas that tend to be less sensitive, use fewer needles in the first session, and employ relaxation techniques. Many patients who were initially anxious about needles become comfortable once they experience how thin the needles are and how effective the treatment can be.
"Can I work out the same day?"
Light activity like walking is encouraged. However, avoid intense workouts, heavy lifting, or training the treated muscle groups for 24-48 hours to give your body time to heal.
"Why am I more sore after dry needling than my friend was?"
Individual responses vary based on factors like how chronic your trigger points are, your pain sensitivity, hydration status, and your overall health. People with very chronic, long-standing trigger points often have more initial soreness as there's more healing that needs to occur.
Your Next Steps
If you're experiencing muscle pain, trigger points, or movement limitations, dry needling combined with comprehensive physical therapy might be exactly what you need. At Well Equipt Physical Therapy in Atlanta, we're committed to not just treating your symptoms but empowering you with the knowledge and tools to maintain your results long-term.
Ready to start your journey toward pain-free movement? Contact us today to schedule your initial evaluation. During your first visit, we'll assess your condition, answer all your questions, and create a personalized treatment plan that may include dry needling along with other evidence-based physical therapy interventions.
Don't let pain control your life any longer. Take the first step toward lasting relief - your future self will thank you.
This guide is for educational purposes and should not replace professional medical advice. Dry needling should only be performed by licensed, trained healthcare professionals. Individual experiences and results may vary. Always consult with a qualified physical therapist or healthcare provider about your specific condition and whether dry needling is appropriate for you.